Comparison of Selective Anterior Versus Posterior Screw Instrumentation in Lenke5C Adolescent Idiopathic Scoliosis

Li, Ming; Ni, Jianqiang; Fang, Xiutong; Liu, Hongtao; Zhu, Xiaodong; He, Shisheng; Gu, Song; Wang, Xin

doi:10.1097/brs.0b013e31819e2b16

Cited by 61 publications

(54 citation statements)

References 15 publications

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“…Selective fusion has gained popularity over decades. 2,3,5–7 Although both anterior and posterior selective TL/L fusion turned out to be effective treatments for AIS with structural TL/L curve and compensatory thoracic curve, 3,8–15 studies have figured out that the anterior method may result in a higher incidence of kyphosis, pseudarthrosis, and loss of correction. 16 Posterior selective TL/L fusion has many advantages like better curve correction, less loss of correction overtime, less loss of blood, and shorter hospital stays over anterior approach, 12 and it has been widely accepted by spine surgeons in recent years.…”

Section: Discussionmentioning

confidence: 99%

Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients

Zhang

Lin

Wang

et al. 2016

Spine

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Study Design.Retrospective study.Objective.To study the behavior of the unfused thoracic curve in Lenke type 5C during the follow-up and to identify risk factors for its correction loss.Summary of Background Data.Few studies have focused on the spontaneous behaviors of the unfused thoracic curve after selective thoracolumbar or lumbar fusion during the follow-up and the risk factors for spontaneous correction loss.Methods.We retrospectively reviewed 45 patients (41 females and 4 males) with AIS who underwent selective TL/L fusion from 2006 to 2012 in a single institution. The follow-up averaged 36 months (range, 24–105 months). Patients were divided into two groups. Thoracic curves in group A improved or maintained their curve magnitude after spontaneous correction, with a negative or no correction loss during the follow-up. Thoracic curves in group B deteriorated after spontaneous correction with a positive correction loss. Univariate analysis and multivariate analysis were built to identify the risk factors for correction loss of the unfused thoracic curves.Results.The minor thoracic curve was 26° preoperatively. It was corrected to 13° immediately with a spontaneous correction of 48.5%. At final follow-up it was 14° with a correction loss of 1°. Thoracic curves did not deteriorate after spontaneous correction in 23 cases in group A, while 22 cases were identified with thoracic curve progressing in group B. In multivariate analysis, two risk factors were independently associated with thoracic correction loss: higher flexibility and better immediate spontaneous correction rate of thoracic curve.Conclusion.Posterior selective TL/L fusion with pedicle screw constructs is an effective treatment for Lenke 5C AIS patients. Nonstructural thoracic curves with higher flexibility or better immediate correction are more likely to progress during the follow-up and close attentions must be paid to these patients in case of decompensation.Level of Evidence: 4

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Section: Discussionmentioning

confidence: 99%

Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients

Zhang

Lin

Wang

et al. 2016

Spine

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“…Several studies have reported the outcomes of patients with thoracolumbar and lumbar AIS treated with pedicle screw constructs; 8,10,[17][18][19]22,25 however, most of these studies reported only 2 years of follow-up. To the best of our knowledge, ours is the first such study to analyze the clinical and radiographic findings of posterior pedicle screw constructs at 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…22 Several studies that compared anterior spinal fusion with pedicle screw fixation for the treatment of thoracolumbar and lumbar AIS reported no statistically significant difference in coronal or sagittal curve correction between the 2 methods at 2 years after surgery. 10,19,25 However, in 2009, Geck et al compared patients with Lenke 5C AIS treated with a posterior release and pedicle screws with those who received anterior instrumentation; they found that at 2 years after surgery, the patients with pedicle screws had statistically significantly better curve corrections, better maintenance of corrections over time, and shorter hospital stays. 8 Although the long-term results for anterior constructs have been reported, clinical and radiographic outcomes of pedicle screw constructs are largely based on short-term follow-up.…”

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confidence: 99%

The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves

Bennett¹,

Hoashi²,

Ames³

et al. 2013

SPI

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T wo approaches (anterior and posterior) are used for the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS). 2,6,7,9,12,13,16,[20][21][22] In 1969, Dwyer et al. first proposed the anterior approach for the treatment of thoracolumbar and lumbar curves with use of vertebral body screws and a compression cable. This approach resulted in good coronal correction but also resulted in a kyphosing effect, poor derotation, and a high rate of pseudarthrosis. 6,7,12,16 Later, to improve derotation, Zielke replaced the wires with an anterior threaded rod, but the kyphosing effect and high rate of pseudarthrosis remained.2,13 Later, dual anterior solid rods were developed and resulted in better coronal correction, improved derotation, and less kyphosis. 21The first posterior approach to be accepted for treatment of thoracolumbar and lumbar AIS was the Harrington method, which used posterior hooks and rods. Shriners Hospitals for Children, Philadelphia, PennsylvaniaObject. Several studies of the outcomes of patients with adolescent idiopathic scoliosis (AIS) with thoracolumbar and lumbar curves after treatment with posterior pedicle screws have been reported, but most of these studies reported only 2-year follow-up. The authors analyzed the radiographic and clinical outcomes of patients with thoracolumbar and lumbar curves treated with posterior pedicle screws after 5 years of follow-up.Methods. A multicenter database was retrospectively queried to identify patients with AIS who underwent spinal fusion for Lenke 3C, 5C, and 6C curves. Radiographs from the following times were compared: preoperative, first follow-up visit, 1-year follow-up visit, 2-year follow-up visit, and 5-year follow-up visit. Chart review included scoliometer measurements, Scoliosis Research Society (SRS)-22 questionnaires, and complications requiring return to the operating room.Results. Among 26 patients with Lenke 3C, 5C, and 6C curves, the mean (± SD) age was 14.6 ± 2.1 years. From the time of the preoperative radiographs to the 5-year follow-up radiographs, there was a statistically significant improvement in the mean coronal lumbar Cobb angles (p < 0.0001), and from the time of the first postoperative radiographs to the 5-year follow-up radiographs, the lumbar curve remained stable (p = 0.14). From the time of the preoperative radiographs to the 5-year follow-up radiographs, there was a statistically significant improvement in the mean coronal thoracic Cobb angles (p < 0.0001), and from the time of the first postoperative radiographs to the 5-year follow-up radiographs, the thoracic curve remained stable (p = 0.10). From the first postoperative visit to the 5-year follow-up visit, the thoracic kyphosis (T5-12) remained stable (p = 0.10), and from the time of the preoperative radiographs to the 5-year follow-up radiographs, the lumbar lordosis (T-12 to top of sacrum) remained stable (p = 0.44). From the preoperative visit to the 5-year follow-up visit, the coronal balance improved significantly (p < 0.05) and remained stabl...

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“…A spontaneous thoracic correction of 36% was shown in this study. Li et al [63] followed patients after selective lumbar fusion in Lenke 5C curves. They found an average of 57% lumbar curve correction and 26% thoracic curve correction with a minimum 2 year follow-up.…”

Section: Selective Thoracolumbar/lumbar Fusionmentioning

confidence: 99%

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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Selective fusion of thoracic and thoracolumbar/ lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature. While some surgeons strongly believe that a more rigid and straighter spine provides predictably excellent outcomes, some surgeons recommend a mobile and less straight spine. This topic is a crucial part of surgical treatment of idiopathic scoliosis, particularly in young patients who will deal with the stress of the fusion mass at the proximal and distal junctions over many years. This study will review the literature on various aspects of selective fusion.

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Comparison of Selective Anterior Versus Posterior Screw Instrumentation in Lenke5C Adolescent Idiopathic Scoliosis

Cited by 61 publications

References 15 publications

Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients

Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients

The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

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